The provision of a prescription to a patient is a medical act.

It is the result of a clinical decision made by a physician subsequent to an evaluation of the patient by the physician. This evaluation should be based on a face-to-face encounter, subject only to certain permissible exceptions when the prescription is for a patient in this province. In the view of the College of Physicians and Surgeons of Newfoundland and Labrador ,an appropriate medical assessment should normally include documentation of an appropriate history and physical examination; reaching a diagnosis; and deciding upon appropriate investigations and therapy. Patient records should clearly reflect that the pertinent elements of the patient evaluation have been completed.

When a medication is prescribed, physicians have a responsibility to advise the patient about such matters as the medication’s therapeutic effects, contraindications, precautions, adverse effects, possible drug interactions and any other information pertinent to the patient’s use of the medication. There is also an obligation for the prescribing physician to arrange appropriate follow-up.

The College has received information which suggests that medical practitioners in this Province have been or may be approached to countersign prescriptions for persons with whom they do not have a bona fide physician/patient relationship.

It is the understanding of the College that typically these prescriptions are originally being written by medical practitioners who are not practicing in the province for patients who do not reside in the province. For the sake of convenience, these prescriptions are referred to below as "extra-provincial prescriptions". Medical practitioners licensed to practice in this province are then approached, sometimes through services known as “Internet pharmacies”, to countersign these extra-provincial prescriptions, usually so that the prescriptions can be dispensed in Canadian pharmacies.

The College has two concerns about the practice of countersigning extra-provincial prescriptions. They are:

1. If countersigning physicians are expressly or implicitly representing that their College licence authorizes them to countersign such prescriptions, then, in the view of the College, this would be a misrepresentation of the authority conferred by the College licence, which only entitles the licence holder to engage in the practice of medicine within the province. Such a misrepresentation may constitute professional misconduct.

2. It would appear that physicians countersigning extra-provincial prescriptions are not conducting an appropriate medical assessment of the person for whom, by the countersigning, they are effectively prescribing. Such a practice may constitute professional misconduct, as well as possibly exposing the countersigning physician to civil liability.

A medical practitioner who is alleged to have countersigned or otherwise facilitated an extra-provincial prescription, under the purported authority of his or her license issued by the College, may be the subject of a complaint and investigation by the College.

Note to Practitioners

See also “Policy regarding Prescribing Practices/Signing or Countersigning Prescriptions for use in the Province” and “Notice to Non-Resident Physicians concerning Prescribing for Patients outside of Newfoundland and Labrador”.